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SOCIAL HEALTH INSURANCE IN MONGOLIA

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Tuvshuu Ganaa

on 6 June 2014

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Transcript of SOCIAL HEALTH INSURANCE IN MONGOLIA

MAIN ACTIVITIES
Strategies
Fully enroll the whole population by extending the coverage to the citizens not covered by health insurance

Tie the rate of contributions of subsidized citizens with minimum wages and expand the benefit package funded by HIF through phased integration

Reduce OOPs to 25% of the total health expenditure
SOCIAL HEALTH INSURANCE IN MONGOLIA
MINISTRY OF POPULATION DEVELOPMENT AND SOCIAL PROTECTION
LEGAL ENVIRONMENT FOR SOCIAL HEALTH INSURANCE
Citizen’s Health Insurance Law was approved in 1993
Amendments were made in 1994, 1997, 1998, 2003 and 2006
Newly revised version of the law was approved in 2002
OOPs for health care are too high
Low satisfaction level of insured
Low quality of health care
Fragmented and overlapping management system
Too much difference between contribution rates
Benefit package is limited, types of services included in the benefit package do not match the needs of insured
REALIGNMENT CHALLENGE OF SOCIAL HEALTH INSURANCE
No integrated database of insured, no progressive technology is introduced
CONTRIBUTION RATES OF SHI
OOP-45.2%
54.8%
Government budget 32.3%
+SHI 22.5%)

Population coverage 94%

Total health expenditure
Director General, Social protection policy implementation department

Munkhzul.L

HEALTH INSURANCE ORGANIZATION
SIGO
Social insurance general office
Health insurance department
Vertical management system
32 branches in total
1400 employees,
109
of which deal health insurance
Social insurance inspectors in every soum (365)
HEALTH INSURANCE CONTRIBUTION SCHEME
Compulsory
Voluntary
All citizens of
Mongolia
Foreigners
CONTRIBUTION RATES
HEALTH INSURANCE SCHEME
Those in the informal sector, herders and unemployed pay approx 8,040 MNT
(5 USD)
per year

The state shall be responsible for the insurance premiums of vulnerable groups & pay 8,040 MNT
(5 USD)
per year

Foreigners pay approx 133,000 MNT (74 USD) per year
SIGO
THE
INSURED
PROVIDERS
Contribution
Benefits
Claims
Payment,
monitoring
Medical services
Co-payment
HI department
CURRENT SITUATION
HEALTH INSURANCE FUND REVENUE AND EXPENDITURE (Billion MNT)
COMPARISON HEALTH INSURANCE FUND REVENUE AND EXPENDITURE 2012
HEALTH INSURANCE COVERAGE COMPARED TO TOTAL POPULATION
Employee's contribution of year 193,400 MNT
(107 USD)
OBJECTIVES
HI COVERAGE
AND REVENUE
Increase the health insurance coverage and ensure stability of the Health Insurance Fund (HIF) so to establish it as a sustainable financial mechanism to fully protect the population in case they need health care
HI BENEFIT PACKAGE
Define the benefit package of health insurance so that the population is provided with health care services in line with all their essential health needs
HI ORGANIZATION
Develop the HIO as an active strategic purchaser of health care services with an insured-centered modern management
Define the policy to allow each citizen to get enrolled to health insurance scheme and receive quality health care without facing financial difficulties
BENEFIT PACKAGE
HEALTH INSURANCE FUND EXPENDITURE 2012
PAYMENT METHODS
10%
at the secondary level hospitals

15%

at the tertiary level hospitals respective of the variable inpatient costs
CO-PAYMENT
Until 2010
From 2010
Case payment
Diagnosis related group DRG
/115 diagnostic groups/
In-patient care services
Out-patient care services
Day care
Diagnostic tests
Traditional inpatient treatment
Palliative care (inpatient)
Rehabilitation services to sanatoriums
Prescription drugs cost;
SHI BENEFIT PACKAGE
Pregnancy and delivery
TB
Cancer
Routine immunization
Sanitation and
disinfection
Primary health care
GOVERNMENT BENEFIT
PACKAGE
GOVERNMENT SUBSIDIZES THE
CONTRIBUTION OF:
Children under 16 years of age and if attending general education school even up to the age of 18,

Citizens with no monetary income except pensions,

One parent taking care of a child up to the age of 2 or up to the age of 3 in case of twins, and

Compulsory military service soldiers.
TOTAL EXP. ON HEALTH % GDP
HUMAN RESOURCES IN HEALTH
HEALTH SERVICE PROVIDERS CONTRACTED WITH SIGO
Health insurance enrollment among self-employed, herders and unemployed is declining
The poor understanding and knowledge about the significance of HI among economic entities and the public leads to evasion of contribution payments and limits benefits received
The collection of HIF contributions is organized by the social insurance organization, but its system is not adequate to reach self-employed workers, herders and unemployed
The mechanism to set the amount of contributions to be paid by insured is not sufficiently developed
l.munkhzul@@mpdsp.gov.mn
Increase effective health insurance coverage and enrollment of citizens through cooperation with all concerned governmental, private sector and non governmental institutions such as
bagh and khoroo governors,
civil registration,
taxation office,
universities, colleges, Vocational Training
Industrial Centers (VTIC),
Mongolian Employers´ Federation (MONEF),
Mongolian National Chamber of Commerce industry (MNCCI),
Confederation of Mongolian Trade Unions (CMTU)
organize contribution collection using appropriate and efficient mechanisms
Conduct continuous social marketing activities in order to increase understanding and knowledge of health insurance among the public
Study methodologies to target groups of the population that are to be subsidized by the government and introduce a targeting mechanism appropriate for the specific characteristics of the country
Finance additional expenses resulting from tying the contributions of citizens subsidized by the government to minimum wages through shifting resources from the government health budget to the HIF
Data from The world bank
Data from The world bank
HERDERS’ INSURANCE COVERAGE
DIFFICULTIES IN COVERAGE OF HERDERS AND INFORMAL SECTOR WORKERS
Promotion campaign faces difficulties, as scattered population is residing in a large territory and living a nomadic life. Herders usually live in soums, the smallest unit of administration and each soum has one social insurance inspector.

Social insurance inspector in a soum:

has no car,
has not got adequate budget for fuel,
lacks other types of supplies.

Income from cashmere: March, April and May:
Income generated from livestock and meat sales: August, September & November
August and September, during this period, herder parents sell meat in order to pay the tuition fees of schools and universities, where their children study.

November: Herders sell particular amount of their livestock during wintertime, when demand of meet increases sharply among the citizens residing in towns.
SOME MEASUREMENTS TO COVER HERDERS AND INFORMAL SECTOR WORKERS IN HEALTH INSURANCE
- to provide the inspectors with cars,
- to increase with budget for fuel,
- to grant bonus for working in a outlying regions,
- to provide with office purposed equipment,
- to involve in trainings,
- to provide with brochures, printed materials.


TO ENHANCE OPERATION OF SOCIAL INSURANCE INSPECTOR IN SOUMS:
To establish and efficiently use database of herders and informal sector workers
To run significant advertisements to sensitize herders and informal sectors
NSIC
HISC
MPDSP
MOH
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